Hemoperitoneum caused by spontaneous rupture of a leiomyoma: A case report

Uterine myomas, fibroids or leiomyomas are benign neoplasms that can present as abnormal uterine bleeding and pressure symptoms. Significant complications are infrequent, but they can be life-threatening. This is a case of a ruptured fibroid where excessive intra-abdominal bleeding resulted in hemoperitoneum. In this clinical scenario, timely recognition and intervention were essential to prevent morbidity and mortality. This article discusses the diagnostic challenges and surgical management of a case of hemoperitoneum resulting from spontaneous haemorrhage from a ruptured vessel on the surface of a subserosal leiomyoma. A 42-year-old patient with a known multi-fibroid uterus awaiting elective surgery presented with acute-onset abdominal pain to the emergency department. She had a distended, tender abdomen. Laboratory tests and contrast computerised tomography revealed haemorrhage with no clear source of bleeding. Emergency midline laparotomy revealed active bleeding from the surface of a posterior subserosal leiomyoma with 1950 mL hemoperitoneum. A total abdominal hysterectomy was performed, and the patient had an uncomplicated recovery. The pre-operative haemoglobin level was 80 g/L, which normalized after several blood transfusions. Histopathological examination confirmed multiple leiomyomas and haemorrhage associated with ischaemic changes. Hemoperitoneum from a bleeding degenerating leiomyoma is an exceedingly uncommon complication. The atypical presentation of abdominal pain and the presence of a multi-fibroid uterus posed diagnostic challenges. This case underscores the importance of considering leiomyomas as a potential cause of acute abdominal pain and bleeding. Timely surgical intervention, supported by a multidisciplinary approach, is essential for optimal patient outcome.